Appeal Resolution Manager jobs in Orlando, FL

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SUMMARY

The Complex/ADR Claim Adjuster will handle disputed claims, as well as other claim assignments as warranted by claim operation needs. Disputed claims may come from the daily, complex, Catastrophe and/or commercial claim units. The Complex/ADR Claim Adjuster will timely review the entire claim file to determine cause, origin and/or duration of the reported loss, evaluate the merits of the loss presented, assess coverage and outcome of the investigation initially completed, if any, evaluate the proper resolution of each claim and will present to management a comprehensive resolution strategy for each claim handled. The ideal candidate is versed in homeowner property damage claims, including when benefits are claimed by Assignment of Benefits (AoB) vendors.  

The Complex/ADR Claim Adjuster may be assigned claims which involve receipt of a Civil Remedy Notice (CRN) and/or Notice of Intent to Sue (NOI), and/or request and/or respond to requests for DFS Mediation and/or appraisal.   The ability to promptly analyze and prepare action plans for the previously referenced scenarios, and present resolution strategies to the claim manager, is required.

Knowledge of insurance regulations claims practices and statutory requirements, governing case law, ADR methodology, DFS mediation and disputed claims resolution is required. The Complex/ADR Claim Adjuster will also serve as a mentor to less experienced adjusters and assist with training, as needed.

The ability to work extended hours, based on customer and business needs, as well as in response to catastrophic weather, is required. A competitive candidate will have a minimum of seven years of experience with first-party, homeowner property claims. Florida, first-party property litigation experience is preferable.  

Job Description, Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Review assigned claims promptly.
• Formulate and execute appropriate ADR strategy in compliance with statutory guidelines.
• Verify facts of loss and pertinent information to analyze and confirm coverage was/is appropriately applied.
• Follow requirements on each file which has a NOI filed to ensure timely resolution pursuant to FL statutes 627.70152 and 627.7152.
• Handle the complete claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make coverage recommendation and issue payments within applicable authority level.
• Review and analyze all claim material to determine the facts of the loss, the investigation completed and/or needed and position file for appropriate resolution.
• Document all claim actions, inclusive of coverage and damage investigations, contacts, phone calls, emails, and correspondences in the claim file.

• Check e-mails and messages daily. Respond to all calls, emails, and questions daily.
• Establish reserves as soon as practical and monitor to adjust at the time of any exposure changing event.

• Respond to insureds, public adjusters, attorneys, contractors, and any additional involved parties to obtain needed information.

• Timely relay status updates to explain settlements and/or ultimate claim disposition.
• Timely submit reserve and payment approval requests, as appropriate.
• Identify claims requiring a Reservation of Rights or denial, draft appropriate coverage
• Correspondence and submit to manager for approval.
• Identify claims best suited to be be resolved through DFS Mediation and/or appraisal and timely demand appropriate option. Handle file through the conclusion of the settlement option chosen.
• Attend mediations and apply technical knowledge to facilitate claim
• Apply advanced negotiation skills to effectuate resolution of disputed claims with insureds or their legal representative.
• Coordinate appraisal process, maintain communication necessary to ensure appraisal process is moving forward in timely fashion.

QUALIFICATIONS:

• Attention to detail
• Ability to multi-task.
• Excellent written and verbal communication skills.
• Effective organizational and analytical skills.
• Ability to work effectively under stress.
• Interpersonal skills necessary to develop relationship with insureds, PAs, opposing counsel, defense counsel, vendors. contractors, peers, and leadership.
• Maintain Florida 520 License. Obtain Alabama, North Carolina, South Carolina, and Georgia, if applicant does not currently possess same, within 30 days of hire
• Minimum of seven years’ claim adjusting experience and/or training in P & C Insurance or equivalent combination of education and experience.
• Effectively use computer and certain software programs.
  

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE:

A four-year college degree is preferred along with prior insurance experience with an insurance carrier or agency. Minimum 7 years’ experience and/or training in P & C Insurance or equivalent combination of education and experience. Minimum of 3 years’ experience in the appraisal process.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

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